Department of Cardiology II, The Second Affiliated Hospital of Dalian Medical University, No.467 Zhongshan Road, Dalian, 116021, Liaoning, People's Republic of China.
Department of Urology I, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116021, Liaoning, People's Republic of China.
BMC Cardiovasc Disord. 2021 Jul 22;21(1):350. doi: 10.1186/s12872-021-02162-8.
Primary aldosteronism (PA), as a cause of secondary hypertension, can cause more serious cardiovascular damage than essential hypertension. The aldosterone-to-renin ratio (ARR) is recommended as the most reliable screening method for PA, but ARR screening is often influenced by many factors. PA cannot be easily excluded when negative ARR.
We report the case of a 45-year-old Chinese man with resistant hypertension. Three years ago, he underwent a comprehensive screening for secondary hypertension, including the ARR, and the result was negative. After that, the patient's blood pressure was still poorly controlled with four kinds of antihypertensive drugs, the target organ damage of hypertension progressed, and hypokalaemia was difficult to correct. When the patient was hospitalized again for comprehensive examination, we found that aldosterone levels had significantly increased, although the ARR was negative. An inhibitory test with saline was further carried out, and the results suggested that aldosterone was not inhibited; therefore, PA was diagnosed. We performed a unilateral adenoma resection for this patient, and spironolactone was continued to control blood pressure. After the operation, blood pressure is well controlled, and hypokalaemia is corrected.
When the ARR is negative, PA cannot be easily excluded. Comprehensive analysis and diagnosis should be based on the medication and clinical conditions of patients.
原醛症（PA）作为继发性高血压的病因，其引起的心血管损害比原发性高血压更为严重。醛固酮与肾素比值（ARR）被推荐为 PA 最可靠的筛查方法，但 ARR 筛查常受到多种因素的影响。ARR 阴性时不能轻易排除 PA。
我们报告了一例 45 岁的中国男性，患有难治性高血压。三年前，他接受了继发性高血压的全面筛查，包括 ARR，结果为阴性。此后，患者的血压仍未得到很好控制，使用了四种降压药，高血压的靶器官损害进展，低钾血症难以纠正。当患者再次因全面检查住院时，我们发现醛固酮水平显著升高，尽管 ARR 为阴性。进一步进行盐水抑制试验，结果提示醛固酮未被抑制；因此，诊断为 PA。我们为该患者进行了单侧腺瘤切除术，并继续使用螺内酯控制血压。术后，血压得到良好控制，低钾血症得到纠正。
ARR 阴性时，不能轻易排除 PA。应根据患者的用药和临床情况进行综合分析和诊断。
